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  • Title: Bone anchor 4-corner cystourethropexy: long-term results.
    Author: Tsivian A, Shtricker A, Levin S, Sidi AA.
    Journal: J Urol; 2003 Jun; 169(6):2244-5. PubMed ID: 12771760.
    Abstract:
    PURPOSE: We evaluate the long-term results of incision less transvaginal bone anchor cystourethropexy to treat genuine urinary stress incontinence. MATERIALS AND METHODS: Between August 1995 and January 1997, 31 women 36 to 81 years old (mean age 58) with types I and II genuine urinary stress incontinence were treated. Four miniature bone anchors (2 on each side of the urethra) attached to a suture were fired transvaginally into the retropubic bone using a bone anchor stapler. The ipsilateral sutures were tied, thus creating a Marshall-Marchetti colposuspension. RESULTS: Of the patients 3 were lost to followup and the remaining 28 were followed for at least 60 months. Only 6 patients (21.4%) are continent. In 5 patients 11 sutures passed through the bladder 5 of which were removed intraoperatively and the other 6 were detected and removed during followup. Incontinence recurred in 1 patient because the sutures cut through the vaginal tissue and were found loose in the retropubic space. In 8 patients 12 anchors had become detached from the bone of which 7 were detected on x-ray in the retropubic area, 2 were removed cystoscopically 1 year later and 3 were spontaneously expulsed through the vagina 10 months to 5 years postoperatively. In 1 patient with intravesical sutures a vesicovaginal fistula developed which was successfully repaired, and in another pubic osteomyelitis developed. CONCLUSIONS: We regard 4-corner bone anchor cystourethropexy as unsuitable for genuine urinary stress incontinence based on the unfavorable outcome of incontinence and high rate of complications, including a relatively high incidence of confirmed anchor detachment.
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